Selective FFR_CT testing in suspected stable angina in clinical practice - initial experiences.

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Coronary CT angiography (CTA) derived fractional flow reserve (FFR_CT) is recommended for assessing intermediate coronary stenosis.
• Guiding referral to invasive coronary angiography (ICA) is crucial for optimal patient management.

Purpose of the Study:

• To evaluate the real-world feasibility of implementing a CTA/FFR_CT algorithm as a gatekeeper to ICA at referral hospitals.
• To assess the impact of FFR_CT on invasive procedure rates and revascularization outcomes.

Main Methods:

• Retrospective study of 3974 patients with suspected coronary stenosis (30-89%) by CTA.
• FFR_CT analysis was performed by skilled CT-cardiologists.
• Decisions for downstream testing (ICA or non-invasive imaging) were based on CTA and FFR_CT results.

Main Results:

• FFR_CT was feasible in 98% of cases, with analysis rejected in only 2% due to image quality.
• 71% of patients were deferred from ICA after FFR_CT, while 27% were referred.
• Revascularization rates were significantly higher in FFR_CT-guided referrals compared to CTA-guided referrals for both 30-69% and 70-89% stenosis.

Conclusions:

• Implementation of FFR_CT at referral hospitals is feasible and effective.
• The CTA/FFR_CT algorithm successfully reduced invasive procedures.
• FFR_CT-guided referral increased appropriate revascularization rates in patients with obstructive coronary artery disease.